Please
realize that completing this questionnaire is in no way a
committment on our part to accept a bitch for breeding. All
information provided is confidential and will only be used to help us
make an informed decision about approving this breeding. We
will respond to your inquiry within 7 days. If
you are inquiring about a dog from our breeding program that we do
not personally own, we will refer this to the dog's owner.

Full Dentition
and Scissors Bite?
Yes NoAny History of
ACL
Tears?
Yes NoHistory of
Pano, OCD
etc?
Yes No

Eye
Color:
Mouth
Pigment:

Bitch's
Sire:
Bitch's
Dam:

Please describe
your bitch's temperament:

What
conformation strengths does your bitch possess?

What would you
like to improve upon?

Please describe
anything in her family history that we should be aware of:

Has your bitch
been bred before?
Yes NoIf yes, did she
whelp naturally?
Yes No

If yes, also
please tell us about her breedings and pups:(Dates bred,
Sires used, number of pups and their titles & health clearances
etc., any DQ faults?)

Section 2:
This Breeding

Are you
planning to do a
Natural Breeding
Fresh Chilled Semen
Frozen Insemination?

If a Natural
Breeding, do you plan to do progesterone testing?
Yes No

If Fresh
Chilled or Frozen, do you have access to a good Reproductive
Specialist?
Yes No

What are your
goals for these pups?

Do you place
companion puppies on spay/neuter or non breeding
contracts?
Yes NoAre you willing
to supply us with copies of both your pet and show
contracts?
Yes NoDo you have
specific homes for the puppies from this breeding lined up now?
Yes NoDo you hope to
keep a puppy from this
breeding?
Yes No

When are you
wishing to do this breeding?

Please list any
other information you wish to supply us with that will help us with
this breeding:

Section 3:
About You

List any COE
Clubs that you are a member of: How long have
you been
breeding?
How many
litters have you
bred?
How many dogs
live with you right
now?

What
titles & health clearances have you obtained on dogs owned by you?

What titles and
health clearances have been obtained on dogs bred by you?

Where
exactly are your puppies whelped and raised?

What are pups fed?

How do you
choose the homes your pups will go to and at what age do you send
them home?